Hospital healthcare provider monitoring and verifyng device and system for patient care condition

ABSTRACT

A hybrid ID system for a medical practitioner and patient care includes a hybrid electronic ID/key having a transmitter device having circuitry for storing ID data and transmitting a signal containing the ID data, and a key having a predetermined shape on a surface of the hybrid electronic ID/key. A radio frequency receptor device having circuitry, storing location information, that detects the signal containing ID data, a matching detection section configured to match the predetermined shape of the key, and a movement tracking portion that tracks movement of the predetermined shape as the key is rotated. A computer system including a patient database is configured to receive the ID data in conjunction with the location information from the radio frequency receptor device when the predetermined shape is completely rotated to a final position, and store the ID data, location information, together with patient data associated with the location.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority to provisionalapplication No. 63/088,758 filed Oct. 7, 2020, the entire contents ofwhich are incorporated herein by reference.

BACKGROUND Technical Field

The present disclosure is directed to a healthcare provider method,system and ID device that facilitate monitoring and verifying ofhealthcare providers to ensure corrective actions are taken in a stricttimely fashion to solve issues that lead to a risk of poorly coordinatedcare of a patient. The monitoring and verifying of healthcare providersincludes a method for risk scoring and inpatient care coordination amongspecialized medical practitioners in a hospital. The risk scoring methodincludes steps for calculating a risk score for a risk of poorlycoordinated care based on assessed criteria, and when the risk score isabove a predetermined level, determining an escalation process to solveissues that lead to the poorly coordinated care. The healthcare providerID device facilitates the escalation process by a communication linkwith a hospital communications system for communicating the risk ofpoorly coordinated care to the hospital administration hierarchy.

Related Art

The “background” description provided herein is for the purpose ofgenerally presenting the context of the disclosure. Work of thepresently named inventors, to the extent it is described in thisbackground section, as well as aspects of the description which may nototherwise qualify as prior art at the time of filing, are neitherexpressly or impliedly admitted as prior art against the presentinvention.

US 2015/0213224, to R. Amarashingham et al., describes a holistichospital patient care and management system. The system includes atleast one predictive model including a plurality of weighted riskvariables and risk thresholds in consideration of the clinical andnon-clinical data and configured to identify at least one medicalcondition associated with patients.

US 2014/0379363, to C. F. Hart et al., describes patient readmissionrisk assessment. A patient risk score may be calculated and used todetermine a likelihood of readmission of a patient. The referenceindicates that being able to identify which patients contribute to aquality metric, identify admissions scenarios that may negatively affecta health care provider's quality score, and being able to determine alikelihood of readmission of a patient early in the revenue cycle may beadvantageous for health care providers. US 2019/0336085, to S. Kayser etal., describes an apparatus for assessing medical risks of a patient andincludes an analytics engine and equipment that provides data to theanalytics engine. The analytics engine analyzes the data from theequipment to determine a sepsis risk score, a falls risk score, and apressure injury score.

US 2014/0214441, to D. C. Young et al., describes a care managementsystem for improving the care of a client who is supported by acaregiver. A risk analyzer may determine the client's risk for differentrisk conditions, and may calculate domain-specific and overall riskscores for the client. The risk analyzer may analyze the informationstored by the caregiver and care management team in the data storagemechanism, in order to evaluate the client for risks of particularconditions, and moreover for an overall risk of negative outcomes. Therisk analyzer may make recommendations for actions to be taken by theclient, the caregiver, or the care management team in order to improvethe client's care.

The risk analyzer of the '441 patent application may makerecommendations for actions to be taken by the client, the caregiver, orthe care management team in order to improve the client's care. However,the '441 patent as well as the other aformentioned references do notprovide a solution to an urgent problem in the field of medical care.Conventional methods used in medical service centers such as hospitalsare unable to assess or objectively characterize poorly coordinated careand thus are unable to effectively improve communication amongclinicians to address poorly coordinated care when it occurs. There is aneed to provide real time monitoring of an individual patient's risk ofpoorly coordinated care and a method of escalating issues related topoorly coordinated care to appropriate decision makers in a hospital.

It is one object of the present disclosure to describe a system andmethod that empowers nurses and junior medical staff to raise concernsabout any compromise to the coordination of patient care. The system andmethod empower patients to receive attention and feedback regarding anyconcerns they have with regard to the coordination of their care. Thesystem and method minimizes the risk of poor medical outcomes byensuring patients are treated under the appropriate service/consultantfor their current clinical needs in a strict timely fashion.

SUMMARY

An aspect of the present disclosure relates to a hybrid ID system for amedical practitioner and patient care. The system can include a hybridelectronic ID/key including a transmitter device having circuitry forstoring ID data and transmitting a signal containing the ID data, and akey having a predetermined shape on a surface of the hybrid electronicID/key; a radio frequency receptor device having circuitry, storinglocation information, for detecting the signal containing ID data, amatching detection section configured to match the predetermined shapeof the key, and a movement tracking portion to track movement of thepredetermined shape as the key is rotated; and a computer systemincluding a patient database. The computer system configured to receivethe ID data in conjunction with the location information from the radiofrequency receptor device when the predetermined shape is completelyrotated to a final position, and store the ID data, locationinformation, together with patient data associated with the location.

A further aspect of the present disclosure relates to a hybrid ID systemfor a medical practitioner and care of a patient. The system can includea hybrid electronic ID/physical key including a radio frequency emissiondevice having circuitry for storing ID data and transmitting a signalcontaining the ID data, and a physical key having a predetermined shapethat protrudes from a surface of the hybrid electronic ID/physical key,the protruding predetermined shape includes a notched portion; a radiofrequency receptor device having circuitry, storing locationinformation, for detecting the signal containing ID data, a depressionthat matches the protruding predetermined shape of the physical key, anda cavity in which the notched portion can move through when theprotruding predetermined shape is rotated in the depression; and acomputer system including a patient database. The computer systemconfigured to receive the ID data in conjunction with the locationinformation from the radio frequency receptor when the protrudingpredetermined shape is completely rotated to a position in which thenotched portions comes into contact with an end of the cavity, and storethe ID data, location information, together with patient data associatedwith the location in the patient database.

A further aspect of the present disclosure relates to a hybrid ID systemfor a medical practitioner and patient care. The system can include amobile device including memory for storing ID data, a first radio signaltransmission device for communicating a first radio signal containingthe ID data, a second radio signal transmission device having circuitryconfigured to communicate a second radio signal at a power and frequencyfor communication at a distance that is shorter than the first radiosignal, a third radio signal transmission device having circuitryconfigured to communicate a third radio signal at a power and frequencyfor communication at a distance that is shorter than the second radiosignal, an orientation measuring device, and processing circuitryconfigured to perform a mobile application; a radio frequencytransmission device having circuitry, storing location information, fortransmitting the second radio signal containing the locationinformation. The mobile application configured to detect a predeterminedmovement gesture, using the orientation measuring device, and apredetermined distance range to the radio frequency transmission devicebased on the second radio signal. A computer system including a patientdatabase, is configured to receive the ID data, via the first radiosignal, in conjunction with the location information from the radiofrequency transmission device when the mobile application detects thepredetermined movement gesture and the predetermined distance range, andstore the ID data and location information, together with patient data,transmitted via the third radio signal, for a patient.

The foregoing general description of the illustrative embodiments andthe following detailed description thereof are merely exemplary aspectsof the teachings of this disclosure, and are not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of this disclosure and many of theattendant advantages thereof will be readily obtained as the samebecomes better understood by reference to the following detaileddescription when considered in connection with the accompanyingdrawings, wherein:

FIG. 1 is a system diagram of Risk Scoring for Patient Care Condition inan exemplary hospital;

FIG. 2 is a block diagram of a general purpose computer in the system ofFIG. 1;

FIG. 3 is an administration hierarchy in an exemplary hospital;

FIG. 4 is an exemplary set of conditions necessary for performing apatient risk assessment;

FIG. 5 is an exemplary escalation process for the patient riskassessment;

FIG. 6 is an exemplary communication protocol for escalation of thepatient risk assessment;

FIGS. 7A to 7D is a flowchart of patient risk assessment in accordancewith an exemplary aspect of the disclosure;

FIG. 8 is a block diagram of a general mobile device;

FIG. 9 illustrates an exemplary healthcare provider id tag in a mobiledevice in accordance with an exemplary aspect of the disclosure;

FIG. 10 is a flowchart of a scan process for the healthcare provider idtag in accordance with an exemplary aspect of the disclosure;

FIG. 11 is a schematic diagram of an exemplary electronic ID badgehaving a physical key in accordance with an exemplary aspect of thedisclosure;

FIG. 12 is a schematic diagram of an ID badge receptor device inaccordance with an exemplary aspect of the disclosure;

FIGS. 13A, 13B is a sequence diagram for communication between the RFIDtag and the scanner or a mobile device and a beacon in accordance withan exemplary aspect of the disclosure;

FIG. 14 is an exemplary screen for a step in the patient risk assessmentin accordance with an exemplary aspect of the disclosure;

FIG. 15 illustrates an exemplary screen that may be displayed as aresult of selecting the medical forms icon in accordance with anexemplary aspect of the disclosure;

FIG. 16 illustrates a section of the risk assessment form containingfields for entering information about the healthcare provider;

FIG. 17 illustrates a section of the risk assessment form containingfields for entering information about a patient;

FIG. 18 illustrates an exemplary risk assessment questions section toassess poorly coordinated care for a particular hospital department inaccordance with an exemplary aspect of the disclosure;

FIG. 19 illustrates an exemplary sub-question for a risk criteria thatrequires further explanation;

FIG. 20 illustrates an exemplary sub-question for a risk criteria thatrequires further explanation;

FIG. 21 illustrates a section of the risk assessment form that displaysa risk score that is calculated based on the answers to the questions inthe risk assessment form;

FIG. 22 is a set of escalation guidelines in accordance with anexemplary aspect of the disclosure;

FIG. 23 is an exemplary escalation process for a department inaccordance with an exemplary aspect of the disclosure;

FIG. 24 illustrates an exemplary documentation of an escalation processin accordance with an exemplary aspect of the disclosure;

FIG. 25 is a step of co-signing by a charge nurse or nurse manager inaccordance with an exemplary aspect of the disclosure;

FIG. 26 illustrates steps for the charge nurse or nurse manager to beginrevising the risk assessment form for a patient as issues are resolved;

FIG. 27 illustrates a portion of an edited version of the riskassessment form in accordance with an exemplary aspect of thedisclosure;

FIG. 28 illustrates a case in which the action taken is that unresolvedissues are escalated to the responsible physician;

FIG. 29 illustrates entry of responsible physician information in orderto obtain a cosign physician list:

FIG. 30 illustrates a cosign options screen for a charge nurse;

FIG. 31 illustrates a risk assessment registry that contains a record ofall patients that have been subject to a risk assessment;

FIG. 32 illustrates options that the responsible physician will beprovided once notified of a request for cosign;

FIG. 33 illustrates an example screen that includes the risk assessmentform;

FIG. 34 illustrates a section of a screen that is automatically opened;

FIG. 35 illustrates a portion of an interface for a responsiblephysician that includes a list of checkboxes for actions that theresponsible physician may choose to take in order to resolve thepatient's unresolved risk assessment issues;

FIG. 36 is a diagram for a recommender system in accordance with anexemplary aspect of the disclosure;

FIG. 37 is\illustrates an exemplary matrix for the recommender system;

FIG. 38 illustrates an exemplary summary of risks identified and whetherthey have been resolved;

FIG. 39 illustrates a subsequent escalation process in a case where theresponsible physician was not able to solve all risk assessment issueswithin the required time period;

FIG. 40 illustrates a portion of a screen that may be displayed to aresponsible physician in order to request a department chairmen tocosign;

FIG. 41 illustrates a portion of a screen that may be displayed to therecipient of the cosign request; and

FIG. 42 illustrates a further escalation process that may occur when thedepartment chairmen could not resolve identified risk issues;

DETAILED DESCRIPTION

In the drawings, like reference numerals designate identical orcorresponding parts throughout the several views. Further, as usedherein, the words “a,” “an” and the like generally carry a meaning of“one or more,” unless stated otherwise. The drawings are generally drawnto scale unless specified otherwise or illustrating schematic structuresor flowcharts.

Furthermore, the terms “approximately,” “approximate,” “about,” andsimilar terms generally refer to ranges that include the identifiedvalue within a margin of 20%, 10%, or preferably 5%, and any valuestherebetween.

Hospital medical care is becoming vastly more sophisticated and highlyspecialized. This creates a challenge and a need for an enhanced levelof coordination of care among highly specialized medical teams to ensurethat the patient stays at the center of the care. In some cases, apatient may be briefly checked on by a physician during an initialconsultation. During a patient's stay, nurses often follow routinepractices to check on the condition of a patient and the patient mayassume that the quality of care is appropriate for the medicalcondition. Often a patient may rate their service upon completion oftheir hospital visit.

However, there may be cases where the nurse that regularly checks thecondition of the patient and the patient have concerns about the initialdiagnosis or the manner that the medical condition progresses during thehospital stay. Possibly, the nurse and/or patient may believe that thepatient should be reviewed by a different physician, should receive adifferent treatment, or should receive a more aggressive treatment. Inother words, something in the treatment protocol may need to be revised,and the nurse and/or patient may need a resource to bring this concernto an appropriate clinician. Possibly a nurse or patient needsassistance in evaluating the treatment plan as it is being performed,rather than when it is completed according to regular practice.

A hospital is typically a large organization which may house hundreds ofpatients and may be served by various nurses, nurse managers andphysicians in several departments. Specialized departments may includeAdult Critical Care, Peds Critical Care, Neonatology

Critical Care, Cardiac Sciences, Medical Services, General Surgery, PedsSurgery, Orthopedics Surgery, Plastic Surgery, Neurosurgery, UrologySurgery, Thoracic Surgery, Ophthalmology Surgery, Vascular Surgery, ENTSurgery, Podiatric Surgery, Neurology/Stroke, OB/GYNE, GynecologyOncology, Hematology, Mental Health, Neonatology, Oncology, OrganTransplant, and others.

The hospital may assign a patient to one department for care based on aninitial consultation with a physician or other consultant who may bepart of an organization that is separate from the hospital, such as anurgent care facility or a patient primary care physician, or with aphysician or other consultant that is resident at the hospital. Such aninitial consultation is the primary method of making a decision as towhich department the patient is to be assigned. The department may be ageneral department that covers a range of medical conditions or may be adepartment for a specific medical procedure.

A patient may be assigned to a room in a department and may stay in thatdepartment for several days or even weeks depending on the extent of amedical condition. During the stay, a nurse may visit the patient whilemaking a routine round to several other patients in the department. Thevisit may be a visit during a certain time of day, such as morning,afternoon, evening. During this routine visit, patient vital signs maybe checked and recorded, and the nurse may ask the patient generalquestions such as how they are feeling. In some cases, the nurse maymake a visual inspection of the patient if the medical conditionincludes external symptoms.

In some cases, the patient may express and/or inform medical staff ofadditional symptoms that have become evident or come to mind during theearly period of the hospital stay, that were not previously noted. Apatient may express changes in medical condition or symptoms that mayhave developed during a hospital stay or may evolve during the stay. Theinitial course of action during this period of change may be to simplykeep an eye on the patient and monitor the change. During this sameperiod, a physician may stop by to check on the patient and ask generalquestions, depending on the medical condition of the patient and theavailability of a physician in the department. In some cases, aphysician for the department may be busy with another patient and maynot have time to visit with some patients in the department until later.

This unstructured visitation by physicians despite changes in themedical condition of a patient may be based on whether the nurse hastaken action to locate the physician and request a visitation. Thelimited number of physicians in the department, and specializedphysicians being located in other departments leads to a condition inwhich a patient competes with other patients for the limited access to aphysician. It may be the case that it is up to the patient themselves ora nurse to make a determination that a certain specialist physicianshould be consulted, priority should be given to the patient based onthe change in medical condition, and/or that the patient should be movedto another department.

Priority to see a specialist physician may be based on qualitativefactors, such as how close a physician is to a patent's room, or thatthe physician is on or off duty during a time period. The patientcertainly cannot make this decision. The primary nurse may not becapable of making the decision.

FIG. 1 is a system diagram for an exemplary hospital computer network.The computer system in FIG. 1 is a centralized network system 100 inwhich various terminals are connected to a centralized computer system110. However, it should be understood that a hospital computer networkmay take on other configurations, such as connections to a computersystem that is located outside of the hospital, or a hierarchicalarrangement in which groups of terminals are connected to local computerservers, and the local computer servers are interconnected or connectedto the centralized computer system 110.

Groups of terminals may be located in each hospital department. Aterminal may be a computer system that is dedicated to one type of user,or may be a computer system that can be accessed by different types ofusers, where each user may be authorized to view certain datainterfaces. For example, a primary nurse may be authorized to viewmedical information about a patient, while a nurse manager may beauthorized to view management information about primary nurses, as wellas medical information about patients in a department. A nurse managermay have access to reports that primary nurses cannot retrieve or view.

Referring to FIG. 1, different terminals are shown for different typesof users for ease of understanding. Such terminals may be the same ordifferent physical computer system. Computer terminals 102 may becomputer systems or client terminals located in each patient room.Client terminals 102 may be associated with a particular hospital bed.The computer terminals 102 may be primarily accessed by a primary nurse,but may be used by a managing nurse or physician provided entry ofappropriate authorization information which may be entered into specificuser interfaces that have been set up based on the type of user.Computer terminals 108 may be located in offices that are used byphysicians or managing nurses, or in shared office space for use outsideof a patient room. Computer terminal 104 may be located in anadministrative office, for example an office of a department chair orother hospital administrator. Computer terminal 106 may be located inanother administrative office.

The hospital computer network 100 may have a connection to an externalenvironment, such as a wide area network that connects to otherhospitals in a hospital group, and/or a connection to regional medicalfacilities, and/or a connection to the Internet. In each case, theconnections to an external environment would typically be secureconnections. In addition connections to an external environment may bewired or wireless connections.

In addition to various computer terminals 102, the hospital computernetwork 100 may include support services, such as printers, scanners,medical imaging machines, X-ray machines, and other special purposemedical hardware devices. In some embodiments, healthcare providers,including primary nurses, charge nurses, responsible physicians, andnurse managers may be provided with a computer-readable tag device 112that can be read by a tag reading device 114. The tag device 112 may beas simple as an RFID device, a mobile device having near fieldcommunications, Bluetooth, or WiFi capabilities. The tag reading device114 may be a RFID reader, a device with near field communication,Bluetooth, or

WiFi, or a scanner for reading a bar code, a magnetic strip, or otherform of close range data transmission.

FIG. 2 is a block diagram for a general purpose computer that mayrepresent basic components of a computer terminal 102, 104, 106, 108, aswell as a server 110.

In one implementation, the functions and processes of the computerterminal 102, 104, 106, 108 or server 110 may be implemented by acomputer 226. Next, a hardware description of the computer 226 accordingto exemplary embodiments is described with reference to FIG. 2. In FIG.2, the computer 226 includes a CPU 200 which performs the processesdescribed herein. The process data and instructions may be stored inmemory 202. These processes and instructions may also be stored on astorage medium disk 204 such as a hard disk drive (HDD) or portablestorage medium or may be stored remotely. Further, the embodiments arenot limited by the form of the computer-readable media on which theinstructions of the inventive process are stored. For example, theinstructions may be stored on CDs, DVDs, in FLASH memory, RAM, ROM,PROM, EPROM, EEPROM, hard disk drive or any other information processingdevice with which the computer 226 communicates, such as a server orcomputer.

Further, patient risk assessment operations may be provided as a utilityapplication, background daemon, or component of an operating system, orcombination thereof, executing in conjunction with CPU 200 and anoperating system such as Microsoft® Windows®, UNIX®, Oracle® Solaris,LINUX®, Apple macOS® and other systems known to those skilled in theart.

In order to achieve the computer 226, the hardware elements may berealized by various circuitry elements, known to those skilled in theart. For example, CPU 200 may be a Xenon® or Core® processor from IntelCorporation of America or an Opteron® processor from AMD of America, ormay be other processor types that would be recognized by one of ordinaryskill in the art. Alternatively, the CPU 200 may be implemented on anFPGA, ASIC, PLD or using discrete logic circuits, as one of ordinaryskill in the art would recognize. Further, CPU 200 may be implemented asmultiple processors cooperatively working in parallel to perform theinstructions of the inventive processes described above.

The computer 226 in FIG. 2 also includes a network controller 206, suchas an Intel Ethernet PRO network interface card from Intel Corporationof America, for interfacing with hospital computer network 100. As canbe appreciated, the hospital computer network 100 can be a publicnetwork, such as the Internet, or a private network such as LAN or WANnetwork, or any combination thereof and can also include PSTN or ISDNsub-networks. The hospital computer network 100 can also be wired, suchas an Ethernet network, or can be wireless such as a cellular networkincluding EDGE, 3G, 4G and 5G wireless cellular systems. The wirelessnetwork can also be WiFi®, Bluetooth®, or any other wireless form ofcommunication that is known.

The computer 226 may further include a display controller 208, such as aNVIDIA® GeForce® GTX or Quadro® graphics adaptor from NVIDIA Corporationof America for interfacing with display 210, such as a Hewlett Packard®HPL2445w LCD monitor. A general purpose I/O interface 212 interfaceswith a keyboard and/or mouse 214 as well as an optional touch screenpanel 216 on or separate from display 210. General purpose I/O interfacealso connects to a variety of peripherals 218 including printers andscanners, such as an OfficeJet® or DeskJet® from Hewlett Packard®.

The general purpose storage controller 220 connects the storage mediumdisk 204 with communication bus 222, which may be an ISA, EISA, VESA,PCI, or similar, for interconnecting all of the components of thecomputer 226. A description of the general features and functionality ofthe display 210, keyboard and/or mouse 214, as well as the displaycontroller 208, storage controller 220, network controller 206, andgeneral purpose I/O interface 212 is omitted herein for brevity as thesefeatures are known.

FIG. 3 illustrates a hierarchy for an exemplary hospital organization.In an exemplary hospital, primary nurses 302 (also referred to as astaff nurse or bedside nurse) are healthcare providers that providedirect patient care, including monitoring, observing and assessingpatients. They are the first point of contact for questions or concernsthat patients may have.

They may perform duties including checking vital signs and recording thevital signs in a log for a patient so that others can view the historyof a patient, and the patient history during a stay is made of record.The primary nurse 302 may provide a patient with any necessarymedications. The primary nurse 302 may ask the patient questions inorder to assess any change in medical condition that the patient may beexperiencing. The primary nurse 302 may perform a visual check of apatient in a case that the patient has external medical conditions, suchas a rash, or other changes in skin condition that may indicate areaction to a medication. The primary nurse 302 may ask questions toobtain a general gage as to whether the patient may have a reaction to amedication, such as whether the patient feels nauseous, has any pain,soreness, stiffness, etc.

A primary nurse 302 may have advanced education and clinical training ina healthcare specialty area, and may make decisions regardinghealthcare. In some cases, a primary nurse 302 may provide patient careand treatment services in collaboration with a physician.

A charge nurse 304 oversees primary nurses 302. A charge nurse 304 maygenerally arrange care and support for patients, as well as other taskssuch as scheduling primary nurses 302 (staff nurses).

A nurse manager 306 directs patient care and provides leadership for adepartment.

In the exemplary hospital, responsible physicians 312 may visit withpatients that have special medical conditions. Responsible physicians312 in a hospital may be general practitioners or may be specialists inareas such as cardiologist, urologist, obstetrician, pediatrician,anesthesiologist, oncologist, to name a few.

A department chair 314 may be a physician that has had considerableexperience with medical conditions that are handled in the department.The department chair 314 may manage physicians for the department.

A chairmen 316 is one that oversees hospital divisions. A chairmen 316may have access to advice from regional services in order to provide abroad range of medical advice. Thus, higher levels of hospitaladministration generally have a broader range of medical knowledge andgenerally manage and direct actions for persons at lower levels.

FIG. 4 is an exemplary set of conditions necessary for performing apatient risk assessment of poorly coordinated care. An initial riskassessment of poor performance and outcomes of the medical practice maybe performed each day for each patient by a primary nurse 302. The riskassessment may lead to an assessment that is provided to the chairman316 for those patients where issues have not been appropriately takencare of in the hospital organization in a timely fashion. There may bepatients where a risk assessment may not be performed. For example, arisk assessment may not be performed during certain days or duringcertain periods 408, where a chairman 316 or other administrationofficial 314 may not be accessible. A risk assessment may not beperformed for a patient that is subject to long-term stay, for example,greater than eight weeks, but currently does not have critical problems410. Otherwise, a risk assessment for poorly coordinated care may beperformed each day for each patient 402. The risk assessment for poorlycoordinated care should be performed for all inpatients, adults andpediatrics in both regular and intensive care unit beds 404. A riskassessment for poorly coordinated care should be performed for long-termcare patients when there are active clinical problems 406.

FIG. 5 is an exemplary escalation process for the patient riskassessment. In cases where the conditions for performing a riskassessment are met, in order to determine whether issues related to poorcoordination among healthcare providers in a hospital are addressed in atimely fashion, a departmental escalation process may be carried outaccording to a strict schedule. FIG. 5 illustrates an example of such astrict schedule. The schedule may include time periods in which certaintasks must be completed. The schedule may include the healthcareprovider that is responsible for the tasks during a time period. Theschedule may include conditions that may be considered when addressingissues regarding the patient risk assessment. The conditions include the“if” conditions shown in FIG. 5. For example, the “if” condition “ifiCARE Score <10, resolve iCARE issues locally” represents a conditionthat may be considered in determining a course of action. The conditionsand courses of action may be configured in the form of a decision tree.The particular conditions and courses of action may vary for eachcondition and risk of poorly coordinated care.

Referring to FIG. 5, in 502, one or more primary nurses 302 are tocomplete a risk assessment form every working day for each patient. Theprimary nurses 302 must complete the risk assessment forms within a timeperiod, for example between 10:00 and 11:00. In a next time period 504,the charge nurse will review risk assessment scores for each patient.The hospital computer network 100 may perform a decision process inorder to determine a next course of action. In one embodiment, if therisk assessment score is less than a predetermined score, the hospitalcomputer network 100 will instruct the charge nurse 304 that issuesraised in the risk assessment form should be dealt with locally in themedical unit/ward that is the responsibility of the charge nurse 304. Ifthe risk assessment score is greater than a predetermined score, thehospital computer network 100 will instruct the charge nurse 304 to havethe issues addressed by a responsible physician 312, referred to as anescalation step. If the charge nurse 304 does not make a decisionregarding a risk assessment score for a patient by the end of the timeperiod 504, the hospital computer network 100 will automatically performan escalation step.

In a next time period 506, the responsible physician 312 must respond tothe escalation and take action to resolve issues indicated in the riskassessment form that led to the risk assessment score. Again, theresponsible physician 312 must complete actions to resolve the issueswithin the time period 506.

If the charge nurse 304 cannot contact the responsible physician 312within the time period 506, or the responsible physician 312 is unableto complete all of the issues within that time period 506, at time 508,the charge nurse 304 will escalate the remaining issues to a departmentchairmen 314. The charge nurse 304 will be given a period of time 510 toreach the department chairmen 314.

If the charge nurse 304 cannot reach the department chairmen within thetime period 510, or if there are still remaining issues to be resolved,the charge nurse 304 may escalate the remaining issues to anorganization (referred to as Corporate Clinical Performance and

Innovation Department, CCPID 320) that will review the issues and takemeasures to ensure appropriate actions are taken to timely resolve theissues. That organization will contact the department chairmen 314 todetermine what courses of action should be taken to resolve remainingissues with a patient(s). A predetermined time period 512 will be setfor the remaining issues to be resolved. If at the end of the timeperiod 512, there are still unresolved issues, an escalation step willoccur to elevate the issue resolution to a chairmen 316 or to a regionalmedical service. In addition, in 514 the organization will communicatewith the charge nurse 304 to inform them of the final resolution.

FIG. 6 is an exemplary communication protocol for escalation of thepatient risk assessment. In one embodiment, the escalation process willbe performed using a pre-established communication protocol. Accordingto the communication protocol, in 602, when a primary nurse 302completes a risk assessment form and a risk score is generated, thecompleted form and risk score will be transmitted to the centralcomputer 110, as well as to a computer terminal 102 of charge nurse 304.In 604, the charge nurse 304 may verify the risk scores and the hospitalcomputer network 100 will submit the risk assessment form to a computerdisplay device associated with the responsible physician 312, such as acomputer terminal 108 or mobile device 112, in accordance with anescalation step. The risk assessments that are submitted to theresponsible physician are for those patients in which the risk score isabove a predefined threshold score and are thus related to patients thathave a high likelihood of experiencing poor care coordination. Thecharge nurse 304 may communicate with the responsible physician 312 inperson, or by way of a phone call, video conference, text message,and/or pager.

In 606, the responsible physician 312 may communicate with the chargenurse 304 via phone or in-person visit to the department (medical ward)as appropriate.

In 608, in the case of an escalation step, a charge nurse 304 maycommunicate with a division chairmen 314 by way of a phone call, videoconference, text message, and/or pager.

In 610, in the case of an escalation step, a charge nurse 304 maycommunicate with an organization (CCPID 320) that is responsible forresolving issues related to poor care coordination. The communicationbetween the charge nurse 304 and the organization 320 may be made by wayof a special direct line.

In 612, the organization (CCPID 320) may communicate with the departmentchairmen 316. The organization (CCPID 320), in 614, may also keep thecharge nurse 304 informed by way of an e-mail, pager, phone call and/ortext message.

FIGS. 7A to 7D is a flowchart of patient risk assessment in accordancewith an exemplary aspect of the disclosure. The process according to theflowchart is performed by way of the hospital computer network 100, aswell as other communications such as pagers and text messages. A riskassessment for poorly coordinated care provides primary nurses 302 andother junior medical staff with information that may raise concernsabout any compromise to the coordination of care. The risk assessmentfor poorly coordinated care enables an input by a patient regardingtheir concerns for the coordination of their care. The risk scoreenables an efficient form of communication of poorly coordinated care tohealth care administration. The risk assessment ensures timelycorrection of issues that contribute to uncoordinated care, includingensuring that patients are treated under appropriate service/consultantfor their current clinical needs. The risk assessment ensures thatpatients are reviewed at a regular interval so that senior healthcareproviders are utilized with improved efficiency.

Different risk forms may be provided for each patient unit/hospitaldepartment, including Adult Critical Care, Peds Critical Care,Neonatology Critical Care, Cardiac Sciences, Medical Services, GeneralSurgery, Peds Surgery, Orthopedics Surgery, Plastic Surgery,Neurosurgery, Urology Surgery, Thoracic Surgery, Ophthalmology Surgery,Vascular Surgery, ENT Surgery, Podiatric Surgery, Neurology/Stroke,OB/GYNE, Gynecology Oncology, Hematology, Mental Health, Neonatology,Oncology, Organ Transplant, and others.

In S702, a primary nurse 302 may log into a computer terminal 102 andselect a risk assessment form that is related to the medical unit wherethe patient has been assigned. In S704, the risk assessment form is tobe completed when the patient's stay meets certain criteria, for examplecriteria as shown in FIG. 4. The patient risk assessment for poorlycoordinated care may be facilitated by an ID tag, such as an ID tagprovided in a mobile device 112.

Types of mobile devices 112 may include a smartphone, tablet computer,laptop computer, or other computer-based device that can wirelesslyconnect to a computer network. In one or more embodiments, the mobiledevice 112 may be a computer-based device having a display device. Inone or more embodiments, the mobile device 112 may include sensordevices, including sensor devices for measuring movement, position,and/or location.

In one implementation, the functions and processes of the mobile device112 may be implemented by one or more respective processing circuits826. A processing circuit includes a programmed processor as a processorincludes circuitry. A processing circuit may also include devices suchas an application specific integrated circuit (ASIC) and conventionalcircuit components arranged to perform the recited functions. Note thatcircuitry refers to a circuit or system of circuits.

Next, a hardware description of the processing circuit 826 according toexemplary embodiments is described with reference to FIG. 8. In FIG. 8,the processing circuit 826 includes a Mobile Processing Unit (MPU) 800which performs processes described herein.

The process data and instructions may be stored in memory 802. Theseprocesses and instructions may also be stored on a portable storagemedium or may be stored remotely. The processing circuit 826 may have areplaceable Subscriber Identity Module (SIM) 801 that containsinformation that is unique to the network service of the mobile device112.

Further, embodiments are not limited by the form of thecomputer-readable media on which the instructions are stored. Forexample, the instructions may be stored in FLASH memory, Secure DigitalRandom Access Memory (SDRAM), Random Access Memory (RAM), Read OnlyMemory (ROM), Programmable Read-Only Memory (PROM), ErasableProgrammable Read-Only Memory (EPROM), Electrically ErasableProgrammable Read Only Memory (EEPROM), solid-state hard disk or anyother information processing device with which the processing circuit826 communicates, such as a server or computer.

Further, embodiments may be provided as a utility application,background daemon, or component of an operating system, or combinationthereof, executing in conjunction with MPU 800 and a mobile operatingsystem such as Android, Microsoft® Windows® 10 Mobile, Apple iOS® andother systems known to those skilled in the art.

In order to achieve the processing circuit 826, the hardware elementsmay be realized by various circuitry elements, known to those skilled inthe art. For example, MPU 800 may be a Qualcomm mobile processor, aNvidia mobile processor, a Atom® processor from Intel Corporation ofAmerica, a Samsung mobile processor, or a Apple A7 mobile processor, ormay be other processor types that would be recognized by one of ordinaryskill in the art. Alternatively, the MPU 800 may be implemented on anField-Programmable Gate Array (FPGA), Application Specific IntegratedCircuit (ASIC), Programmable Logic Device (PLD) or using discrete logiccircuits, as one of ordinary skill in the art would recognize. Further,MPU 800 may be implemented as multiple processors cooperatively workingin parallel to perform the instructions of the inventive processesdescribed above.

The processing circuit 826 in FIG. 8 also includes a network controller806, such as an Intel Ethernet PRO network interface card from IntelCorporation of America, for interfacing with network 824. As can beappreciated, the network 824 can be a public network, such as theInternet, or a private network such as LAN or WAN network, or anycombination thereof and can also include PSTN or ISDN sub-networks. Thenetwork 824 can also be wired, such as an Ethernet network. Theprocessing circuit may include various types of communicationsprocessors for wireless communications including 3G, 4G and 5G wirelessmodems, WiFi®, Bluetooth®, GPS, or any other wireless form ofcommunication that is known.

The processing circuit 826 includes a Universal Serial Bus (USB)controller 825 which may be managed by the MPU 800.

The processing circuit 826 further includes a display controller 808,such as a NVIDIA® GeForce® GTX or Quadro® graphics adaptor from NVIDIACorporation of America for interfacing with display 810. An I/Ointerface 812 interfaces with buttons 814, such as for volume control.In addition to the I/O interface 812 and the display 810, the processingcircuit 826 may further include a microphone 841 and one or more cameras831. The microphone 841 may have associated circuitry 840 for processingthe sound into digital signals. Similarly, the camera 831 may include acamera controller 830 for controlling image capture operation of thecamera 831. In an exemplary aspect, the camera 831 may include a ChargeCoupled Device (CCD). The processing circuit 826 may include an audiocircuit 842 for generating sound output signals, and may include anoptional sound output port.

The power management and touch screen controller 820 manages power usedby the processing circuit 826 and touch control. The communication bus822, which may be an Industry Standard Architecture (ISA), ExtendedIndustry Standard Architecture (EISA), Video Electronics StandardsAssociation (VESA), Peripheral Component Interface (PCI), or similar,for interconnecting all of the components of the processing circuit 826.A description of the general features and functionality of the display810, buttons 814, as well as the display controller 808, powermanagement controller 820, network controller 806, and I/O interface 812is omitted herein for brevity as these features are known.

The mobile device 112 may include sensor devices 850. Sensor devices 850may include an accelerometer for measuring movement and orientation,geomagnetic field sensor to determine position, a Global PositioningSystem for determining location, as well as other sensors for detectingenvironmental conditions, proximity, and light to name a few.

FIG. 9 illustrates an exemplary healthcare provider ID tag in accordancewith an exemplary aspect of the disclosure. A healthcare provider ID tagmay be an electronic badge worn by a healthcare provider and may have anembedded RFID tag detectable by an RFID reader. Alternatively, thehealthcare provider may be provided with a mobile device 112 having aninstalled mobile application 904 (also referred to as an App), in whichthe mobile application 904 contains a detectable image displayed in adisplay device 902 associated with a tag ID. In one embodiment, themobile application 904 may include a user login function 908 thatrequires that a user log into the mobile application 904 in order toauthenticate the user. Once logged in, the mobile application 904 mayassociate the detectable image with an id 906 of the healthcareprovider.

The detectable image displayed by the mobile application 904 can be abar code (2D or 3D) that is scanned by a scanner 114, in which thescanner 114 has a fixed location that is used to identify the locationof the healthcare provider and a time that the healthcare providerenters the location. The detectable image may again be scanned when thehealthcare provider exits the location having the scanner 114. Themobile application 904, once the healthcare provider has logged in, willestablish a link to a patient's electronic medical record for a patientstaying at the location (hospital room). The link may be by way of awireless link to the hospital central computer system 110, or may be byway of a communication link with a computer terminal 102 in a hospitalroom. In the case that more than one patient is staying in a hospitalroom, the link to a patient's medical record will be based on a terminal102 that is associated with a particular hospital bed. The link alsoestablishes a connection to a risk assessment form for a patient. Thelink may be configured to cause identification information of thehealthcare provider to be populated in a risk assessment form.

FIG. 10 is a flowchart of a scan process for the healthcare provider idtag in accordance with an exemplary aspect of the disclosure. In oneembodiment, the scanner 114 and mobile application 904 perform ascanning and communication process that may be used to facilitate stepsin the patient risk assessment. When a healthcare provider begins a taskthat may result in a step in an escalation process, in S1002, thehealthcare provider first scans the id tag with scanner 114, for examplean id tag displayed in the mobile application 904. Upon scanning the idtag, in S1004, a clock of the mobile application 904 registers a starttime (for example, a time that a healthcare provider first enters apatient room). In addition, in S1006, the mobile application 904establishes a link with the electronic medical record for a patient. Asmentioned above, the link may be a wireless connection to the centralcomputer system 110 or via a computer terminal 102. The link triggersautomatic information about the healthcare provider to be entered intoforms maintained in the central computer system 110. As actions aretaken by a healthcare provider, the healthcare provider may check offissues related to the risk assessment form that are addressed. In S1008,an action taken by the healthcare provider to resolve an issueassociated with the risk assessment may be checked in the riskassessment form as a resolved issue. In S1010, the mobile applicationwill register a stop time that the resolved issue is checked in the riskassessment form.

In some embodiments, dual or triple verification of a patient visit by ahealthcare provider may be used to ensure that the healthcare providerhas visited the patient within an allotted time constraint to addressone or more issues related to poor coordination of patient care. Properrecordation of physician identification, nurse identification or otherhealthcare provider identification is complemented through the use of anID badge system that permits both electronic and physical verificationof identification of the healthcare provider. Healthcare providersinvolved in care of a patient may be assigned a “practitioner ID badge”that permits virtual identification and tracking of a healthcareprovider, and physical confirmation of identification and inpatientvisitation.

FIG. 11 is a schematic diagram of an exemplary electronic ID badgehaving a physical key. FIG. 12 is a schematic diagram of an ID badgereceptor device. For electronic verification of identification of thehealthcare provider, the electronic ID badge 1100 may be configured withan RFID tag 1106, embedded within one side 1102 a, that can emit a radiosignal 1108. In one embodiment, the RFID tag 1106 may be a passivedevice that emits a radio signal 1108 when interrogated by an RFIDreceptor device. that the RFID tag 1106 facilitates constant monitoringof a healthcare provider throughout the hospital facility on a full-timebasis.

The RFID tag 1106 may be detected and monitored throughout the hospitalenvironment with RFID detectors preferably located at average chestheight at every doorway. Upon approaching a doorway, a practitioner's IDtag 1100 can be detected and recorded by the RFID detector thentransmitted to the central computer system 110 by wireless or directelectronic connection and stored in a database.

For physical verification, the ID badge may also include a physical key1110, having a specific shape, or an electronic pattern having aparticular orientation. The physical key may be located on the backsurface 1102 b of the ID badge 1100. The physical key shape is acircular protrusion from the back surface of the ID badge. The outercircumference of the top surface of the circular protrusion may includea notched portion 1112 such that the ID badge 1100 must be oriented in aparticular orientation in order to fit an ID badge receptor device 1202located on or near the patient. The notched portion 1112 may include anelectrical contact 1114.

When a clinician or healthcare provider, preferably a physician,interacts with a patient the physician first initiates a recordation ofthe physician's visit to the patient by locking into a matchingreceptacle on or near the patient. The matching receptacle, of the IDbadge receptor device 1202, is a circular depression 1204 that matchesthe diameter of the circular protrusion 1110 on the back 1102 b of theID badge 1100. In particular, the physician first places the circularprotrusion 1110 in the depression 1104 then turns the ID badge 1100 inorder to “lock in” and verify that the physician's visit to the patientis being recorded. Typically a quarter turn of the ID badge 1100 isneeded in order to trigger recordation of the physician's visit. Theelectrical contact 1114 may move during the turn within a cavity 1206 tobe brought into contact with a mating electrical contact 1208 of the IDbadge receptor device 1110. The ID badge 1100 may have indents 1104 onone side 1102 a to assist in grasping the ID badge 1100 when turning theID badge 1100.

In embodiments of the invention physical recordation of the physician'svisit is carried out only during an escalation process. Physicalrecordation makes a clear record that issues regarding lack ofcoordination of care are receiving direct and personal attention of aphysician.

As an alternative to the practitioner ID tag, a mobile device 112, inpossession of a healthcare provider, equipped with Bluetooth Low Energy(BLE) and Near Field Communication (NFC) together with a communicationsystem may be used in dual or triple verification of a patient visit bya healthcare provider. The mobile device 112 may also be used to track ahealthcare provider's location. FIGS. 13A, 13B is a sequence diagram forcommunication between the mobile device 112 and a beacon, to monitorlocation of the healthcare provider, and between the mobile device 112and a patient badge, to verify the location as proximate to theparticular patient.

The mobile device 112 may contain a BLE detector 818. Beacons 1320 maybe deployed throughout the hospital so that the location of the mobiledevice 112 can be monitored. The mobile device 112 may be associatedwith the ID of the healthcare provider by way of authentication of thehealthcare provider with the mobile device 112. The authentication ofthe healthcare provider may be performed by conventional methods, suchas a user name and password, or two factor authentication, or otherauthentication methods, such as fingerprint or voice print. Provided theauthentication, the location of the mobile device 112 will constitute alocation of the healthcare provider. Beacons 1020 may be configured as aBLE transmitter to, in S1322, transmit a periodic signal from the fixedposition of the beacon 1320. The mobile device 112, in S1324, can detecta transmitted BLE signal by BLE detector 818 and, in S1326, will collectthe ID and location of the beacon 1320. In S1328, the location data incombination with the ID, and, in S1330, is forwarded to the hospitalcentral computer 110 to determine the mobile device's location. Thecommunication between the mobile device 112 and the hospital centralcomputer 110 may be performed using WiFi.

The position of the beacon 1320 may be at the entrance to a patientroom, and in that case, in S1332, the mobile device's location may bedetermined by the hospital central computer 110 as being the entrance tothe patient room. In one embodiment, the mobile device 112 will beprovided with a geographic map that indicates the location of the mobiledevice.

In S1342, the mobile device 112 may perform a dual verification that thehealthcare provider is located at a particular patient room. The mobiledevice 112 can detect the transmitted BLE signal and will collect the idand location of the beacon 1320. In addition, the mobile device 112 canbe configured to detect distance and orientation such that the mobiledevice 112 is required to be placed at a specific orientation anddistance relative to the beacon 1320, then moved to a second orientationand distance in a certain path, as a second verification that the mobiledevice 112 is located at the patient room. The movement and orientationmay be detected using an accelerometer. The distance relative to thebeacon 1320 may be determined based on the strength of the BLE signal.The first verification including the location and id of the beacon 1320may indicate a temporary location of the mobile device 112 as it passesby the beacon 1320. Upon completion of the second verification, the IDof the healthcare provider, the patient room that the mobile device islocated may be automatically transmitted to the hospital centralcomputer 110.

The mobile application 904 may be configured to record a time to markbeginning of care for a patient when the mobile application 904 detectsthe predetermined movement gesture and the predetermined distance rangeand creates a link between the ID data and the patient's electronicmedical record.

A patient may be provided with a patient badge that storesidentification information of the patient. Reading identificationinformation of the patient may be used to verify a location as proximateto the particular patient. In S1344, the mobile device 112 may beconfigured to function as a near field communication (NFC) device andcan read the identification information of the patient from the patientid badge. The mobile application 904 may be configured to automaticallytransmit the patient identification information to the central computer110 to be related to the ID of the healthcare provider.

In S1346, the mobile application 904 may display a user interface forinputting a report of actions taken with the patient, such as a list ofcheckboxes for actions that may be taken.

At a period of time after beginning of a patient visitation, the mobiledevice 112 may detect that it is being moved out of the patient room. InS1348, the mobile device 112 may transmit a message to the hospitalcentral computer 110 that includes time and location of the mobiledevice 112.

FIG. 14 illustrates an exemplary screen for accessing the nursing recordsection of a hospital care system. The nursing record 1402 may be acomponent in the central computer system 110. A primary nurse 302 mayselect an icon 1404, among icons in the nursing record 1402, that bringsup medical forms.

FIG. 15 illustrates an exemplary screen that may be displayed as aresult of selecting the medical forms icon 1304. The exemplary screen1502 may display a list of medical forms 1504. In the screen 1502 ofFIG. 15, a primary nurse 302 may select a risk assessment form 1510 fromamong listed forms 1504. The risk assessment form 1510 may be a formthat is specific to a department (medical ward) that is associated witha particular patient. When the risk assessment form 1510 is selected,the exemplary screen 1502 may display a history of risk assessment forms1508 associated with a patient. The exemplary screen 1502 may display arisk assessment form 1506 that may be filled in next. FIGS. 16 to 21illustrate particular sections of the risk assessment form 1506.

FIG. 16 illustrates a section of the risk assessment form containingfields for entering information about the healthcare provider. In S706,the healthcare provider information may be populated. A healthcareprovider section 1602 includes fields that may be populated withhealthcare provider information associated with the healthcare providerid when the healthcare provider id tag is scanned, S1002. The fields mayinclude a field 1604 for the name of the healthcare provider, a field1608 for the ward that the healthcare provider is part of, and a field1606 for a badge id number for the healthcare provider.

FIG. 17 illustrates a section of the risk assessment form containingfields for entering information about a patient. Some of the fields forthe patient information may be populated based on information providedwhen the patient is first assigned to a patient room. The patient unitfield 1708, for example, will be populated based on the department thata patient is assigned upon admission to the hospital. Likewise, thepatient name field 1704 and patient medical registration number 1706 maybe populated with information of the patient obtained when the patientis admitted to the hospital. The patient name, medical registrationnumber and patient unit may be populated by way of a terminal 102located in the patient hospital room.

Remaining patient information including in 5708, a diagnosis field 1710and responsible physician field 1712 may be entered by a primary nurse302 during the period 502 of filling out the risk assessment form. Inone embodiment, the diagnosis field 1710 may be filled in based oninformation that has been completed by a responsible physician 312during an initial consultation with the patient. The initialconsultation with the responsible physician 312 may take place duringadmission to the hospital, or at some period before the patient isassigned to a department. In some situations, a patient may be admittedto the hospital and transferred to a room for initial consultation forpurposes of examining the patient and determining an appropriatedepartment that the patient may be assigned. The responsible physician312 may enter a diagnosis into the patient's electronic medical recordat the time of the initial consultation, or may enter the diagnosis at alater time. The primary nurse 302 may populate the diagnosis field 1710by performing a search function (pressing a search button) and selectinga diagnosis term 1720 to be used to populate the field. In a similarmanner, in S710, the patient's responsible physician field 1712 may bepopulated by performing a search function (1730) to search amongphysicians based on the responsible physician's name, badge number, ordepartment in order to obtain the information 1732 for the responsiblephysician.

FIG. 18 illustrates an exemplary risk assessment questions section toassess poorly coordinated care for a particular hospital department. Thequestions section 1802 may be a list of checkboxes that may easily bereviewed and checked by a primary nurse 302. In S712, the primary nurse302 may address the questions based on a consultation with the patient,and a physical and visual examination of the patient during the timeperiod 502. The questions may be related to potential concerns about acompromise to the coordination of care that the primary nurse mayobserve during the consultation and visual examination. Some questionsmay relate to concerns that a patient may express during theconsultation with the primary nurse 302. For example, the patient mayexpress a concern that the medical condition appears to be gettingworse, that there may be symptoms that come to mind after the initialconsultation with the responsible physician, or other issues that mayreflect a concern as to whether the treatment is sufficient or should bemore aggressive, or may have been misdiagnosed.

In S716, the questions section 1802 requires that all questions to beaddressed in order for a risk score to be generated in S718. In someembodiments, a question section 1802 must be completed before the riskassessment will allow the primary nurse 302 to move on to a next screen,or log out of the risk assessment. In one embodiment, if a Yes or Nocheckbox is not selected, an automated risk score will be generated bydefault.

In S714, some questions may involve sub-questions in order to fullyanswer the question. Some questions may require further explanation.

FIG. 19 illustrates an exemplary sub-question for a risk criteria thatrequires further explanation. Some questions may best be answered with aquantitative value that may change based on visits with a patient.Regarding FIG. 19, an issue regarding coordination of care may be that apatient requires one of more consultations. The risk assessment form mayinclude one or more fields into which the type of consultation may beentered for each consultation. In one embodiment, when a response to aquantitative question is “YES,” the form may expand into a list ofcheckboxes to aid in selection of a quantity and an associatedexplanation or description related to the quantity. In the case thatthere is a sequence of quantities, each quantity up to the presentquantity may be accompanied by an explanation or description. In someembodiments, a greater quantity may contribute to a higher risk score. Arisk score may change each time a primary nurse 302 completes a riskassessment form.

In the example illustrated in FIG. 19, the question 1902 is whether apatient has had one or more consultations, in some cases with differentresponsible physicians 312 or healthcare givers/consultants in differentdepartments. When the checkbox “YES” 1904 is checked, the question willexpand to a list of checkboxes 1906. The current consultation will beindicated by a check in the checkbox 1908. In the example shown in FIG.19, it can be seen that this particular patient may have hadconsultations with different departments, possibly indicating concernsor difficulty in determining a medical condition for this patient.

FIG. 20 illustrates an exemplary sub-question for a risk criteria thatrequires further explanation. A question concerning a cancelation ordelay of one or more procedures 2002 may raise an issue related to poorcoordination of care. The example question 2002 may concern whether aprocedure or procedures has been delayed or canceled due to non-clinicalreasons. When the checkbox “YES” 2004 is checked, the question willexpand to a list of checkboxes 2006. A sequence of checkboxes may show ahistory of procedures that have been canceled or are being delayed. Thecurrent procedure that is being delayed or canceled may be indicated bya check in a checkbox 2008. The number of procedures that have beendelayed or canceled may contribute to a higher risk score. It can beseen that this particular patient may have had miscommunication ofdiagnosis or miscommunication in a medical condition that caused aprocedure to be delayed or canceled.

FIG. 21 illustrates a section of the risk assessment form that displaysa risk score that is calculated based on the answers to the questions inthe risk assessment form. In S718, a risk score may be determined basedon values selected in the risk assessment form that is completed ondaily basis for each hospital stay day to reflect the risk of poorlycoordinated care as the patient's condition or clinical needs changeover time. When none of questions in the risk assessment form areapplicable for a patient, a default risk score of zero will be displayedin the form. In some embodiments, the primary nurse 302 that completedthe risk assessment form will be required to save the completed form byactivating a save function 2104. In some embodiments, the primary nurse302 that completed the risk assessment form will be required to sign thecompleted form and associated risk score.by activating the sign function2106. The saved form may be stored in a database in the central computersystem 110.

Risk assessment forms are to be completed for all patients before theend of period 502. Within a predetermined time period, the charge nursewill review the risk assessment screen of their unit, for any patientwithout a score, charge nurse will review the patient electronic medicalrecord with the patient's primary nurse and review the patient'seligibility for form completion and ensure form completion for alleligible patients.

In S720, in period 504, the charge nurse 304 will be provided with adisplay of risk scores for all patients in their department (ward). Thecharge nurse 304 may verify scores by reviewing the risk assessment formassociated with the particular patient. According to an escalationguideline, as in FIG. 22, in S722, a risk score of zero may lead to anaction that the risk assessment will be performed the next day.According to the escalation guideline, in S724, a risk score that isgreater than zero but less than a predetermined threshold, for example arisk score threshold of 10, will be resolved locally, in S726, by theprimary nurse 302 and charge nurse 304. Only those patients having arisk score of greater than the predetermined threshold may be subjectto, in S728, an escalation process.

In S728, the escalation process involves communication based on theescalation communication protocol.

FIG. 23 is an exemplary list of healthcare provider to be communicatedwith in the case of an escalation process. In one embodiment, unresolvedrisk issues may be communicated using a video conference system or viae-mail. In the embodiment, a risk assessment support team may bedesignated as preferred points of contact for resolving risk issuesrelated to poorly coordinated care.

FIG. 24 illustrates an exemplary documentation of an escalation processin accordance with an exemplary aspect of the disclosure. In 5730, anescalation process may be initiated with a primary nurse 302 assigned tothe patient. The identifying information of the primary nurse may becaptured using the id tag of the primary nurse or by scanning the mobileapplication icon 906, as discussed above. An escalation process form2402 may be automatically populated with the primary nurse'sidentification information 2404. The escalation process form 2402 mayinclude checkboxes 2406 for actions taken to escalate risk issues. Inthe example shown in FIG. 24, the action checkboxes 2406 include actionsof notified the charge nurse, charge nurse is unavailable, referred tothe nurse manager. Other actions taken may be entered by the primarynurse.

When the primary nurse takes an action to notify a charge nurse of nursemanager, the information of the charge nurse or nurse manager ispopulated in fields 2408. FIG. 25 is a step of co-signing by a chargenurse or nurse manager. In one embodiment, the charge nurse or nursemanager are required to enter credentials as a verification of theescalation process initiated by the primary nurse. Once the credentialsof the charge nurse or nurse manager have been entered, the primarynurse may save the escalation document 2002 in the central computersystem 110.

FIG. 26 illustrates steps for the charge nurse or nurse manager to beginrevising the risk assessment form for a patient as issues are resolved.In S732, actions taken to resolve risk issues may be performed based ona timer, for example, in the mobile device 112. Any issues that remainunresolved by the end of a predetermined time period may automaticallybe subject to an escalation process. The most current risk assessmentform for a patient may be accessed by selecting the form 2602 from alist of forms by the charge nurse or nurse manager. A set of editoperations may be enabled upon selection of an EDIT button 2604.

FIG. 27 illustrates a portion of an edited version of the riskassessment form. In S734, the edited version 2702 contains a list ofcheckboxes 2706 that upon being checked show actions that the chargenurse or nurse manager took in an attempt to resolve any uncoordinatedcare issues. The edited version 2702 may be populated withidentification information 2704 of the charge nurse or nurse manager.The list of checkboxes, as shown in the example in FIG. 27, may includeactions of reviewed the patient's medical plan, escalated to the nursemanager, escalated issues to the responsible physician, escalated todepartment chairmen, issues remain unresolved and escalated to CCPID.Other actions taken, not listed, may be entered by the charge nurse.

FIG. 28 illustrates a case in which the action taken is that unresolvedissues are escalated to the responsible physician. In S740, a message,for example in the form of an e-mail, will be sent to the responsiblephysician. The charge nurse or managing nurse enters the identificationinformation 2802 for the responsible physician that has been notified.The charge nurse or managing nurse will save using a save button 2804the responsible physician information to the central computer system110.

In one embodiment, the responsible physician that has been notified ofthe unresolved issues is required to cosign the entry of identifyinginformation. The requirement to cosign may be displayed as an indication2806 in the identification entry section. Upon completion of entry ofresponsible physician information, a cosign physician list will beprovided, as shown for example in FIG. 29. The co-sign physician listmay be a drop down list 2904 of physician names for a department 2902.Upon selection of the responsible physician from the drop down list, anautomated push notification will be sent to the selected responsiblephysician in their cosign options screen. An example of a cosign optionsscreen for a charge nurse is shown in FIG. 30.

FIG. 31 illustrates a risk assessment registry that contains a record ofall patients that have been subject to a risk assessment. The riskassessment registry 3102 may document patients that have a risk scoreabove a predetermined risk score threshold, such as 10, and may includea record of the cumulative risk score 3104. In one embodiment, the riskassessment registry 3102 may summarize the escalation path 3102 that hadbeen used. The risk assessment registry 3102 may document the risksidentified 3108 and the actions taken 3110 to resolve the risks.

FIG. 32 illustrates options 3202 that the responsible physician will beprovided once notified of a request for cosign. In S742, the responsiblephysician may be presented with a list of cosign items 3212 upon logginginto their interface and selecting a Cosign button 3204.

In S744, when a responsible physician selects an item for cosign 3214,the risk assessment form will automatically open for the department withregard to the patient associated with the risk assessment. FIG. 33illustrates an example screen that includes the risk assessment form3302.

The responsible physician may be faced with situations in which thereare conflicts between patients that need to be resolved in a limitedtime period. In S746, a decision is made as to whether there is apotential conflict between patients. In S758, the central computersystem 110 may perform an analysis in order to resolve cases in whichthere are conflicts between patients. For example, there may be anunusually large number of patients having high risk assessment scoressuch that a responsible physician may not be able to address all riskassessment issues in the designated time period. In some cases the highlevel risk score or criteria list may require further explanation inorder to obtain a better understanding of the issue and possiblesolutions.

As one example, a risk criteria for a patient may indicate that thepatient has had several consultations with physicians from variousdepartments. Such a case may be an indication that the patient hasmultiple medical conditions that need to be addressed, or may be anindication that the patient's condition is difficult to determine or maybe quickly changing and becoming more severe.

The present responsible physician may need further explanation in orderto determine the reason for the various consultations. This case may bereflected by a risk assessment score that is determined not just on thenumber of consultations, but also on the types of consultations. Thehigh risk assessment score may be given high priority so that theresponsible physician may spend some time performing further research onthe reason for the high score.

In one embodiment, the risk assessment score may be determined based ona decision tree. Also, one approach may be a decision tree in which therisk assessment score is a category, rather than a numerical value. Forexample, the risk assessment score may be one of several qualitativevalues, such as no risk, medium risk, and high risk. Patients that havea risk score of medium risk may be subject to resolution locally, whilepatients that have a risk score of high risk may require escalation.

A risk assessment score decision tree may be learned over time. Forexample, one of several known inductive learning algorithms may beapplied that takes as input training examples, and produces aclassification-type decision tree. Training examples may be based on ahistory of past patient risk assessment scores and the associatedconditions that lead to those scores (see for example conditions inFIGS. 18-20). In one embodiment, the completed risk assessment form andassociated score may be stored in a database in the central computersystem 110. Values of the risk assessment form and resulting scores maybe used as training examples for a classification-type decision tree.

Alternatively, the decision tree may be used to determine actions that aresponsible physician should take based on risks that are identified. Inone embodiment, the data logged into the registry, as shown for examplein FIG. 31, may be used to create a decision tree for decidingrecommended actions. In one embodiment, a decision tree may include:

If the risk assessment is high risk and the primary nurse 302 indicatesthat the patient is not in an appropriate department for current medicalneeds, the central computer system 110 automatically escalates to theresponsible physician 312 to visit the patient and further evaluate anappropriate department for the patient. If the risk assessment is highand the primary nurse 302 indicates that the patient is not beingevaluated by an appropriate responsible physician 312 for the currentclinical needs, the central computer system 110 automatically escalatesto a department chairmen 314 to evaluate an appropriate responsiblephysician 312 for the current clinical needs.

As the amount of data stored in the registry becomes large, the data maybe used by a recommendation engine in order to provide recommendedactions based on similar risk assessments.

FIG. 34 illustrates a section 3402 of a screen that is automaticallyopened. In S748, the responsible physician may choose to edit (editbutton 3404) the risk assessment form in order to document any actionstaken for the unresolved issues. At this time a scan process as in FIG.10 may commence. The responsible physician will be given a certainperiod of time to solve identified risk assessment issues.

FIG. 35 illustrates a portion 3502 of an interface for a responsiblephysician that includes a list of checkboxes 3504 for actions that theresponsible physician may choose to take in order to resolve thepatient's unresolved risk assessment issues. In S750, the responsiblephysician may review the list and select actions that will be performed(by clicking on an associated checkbox). Among the actions that aresponsible physician may take to resolve the patient's issues mayinclude review the patient's medical record, acknowledge and act onidentified issues, ensure an integrated care plan is completed, contactconsulting services to resolve issues, could not resolve the identifiedissues, and escalate to either a division chairman, a departmentchairman, or CCPID.

FIG. 36 is a diagram for a recommender system. The recommender system3600 may be used for providing actions to resolve a risk identified thatare based on similar assessed criteria in risk assessments. Therecommender system 3600 works off of an indexed database 3610 of actiondata and action filters. The indexed database 3610 may be populated withdata from a registry (see FIG. 31) stored in a database in the centralcomputer 110. The recommender system 3600 may include an interpreter3604 that extracts data from the registry and stores a relationship ofrisk and actions in a database 3606. Data in the risk and actionsdatabase 3606 may be indexed by an index processing operation 3608 andthe indexed data is stored in the indexed database 3610.

The recommender system 3600 includes a recommendation engine 3612 thatretrieves and ranks recommendations. In the case of actions for aparticular risk identified, a recommendation may be for the riskidentified in a risk assessment form. In some embodiments, therecommendations may be retrieved based on user preferences or typicaltypes of actions. Personal user preferences may be actions that ahealthcare provider has entered when the hospital network system 100 isfirst set up. Typical features may be actions that a healthcare providerwould normally take given the risk identified.

In some embodiments, the recommendation engine 3612 may use an actionmatrix. FIG. 37 illustrates a non-limiting action matrix in accordancewith an exemplary aspect of the disclosure. The action matrix in FIG. 37is a partial matrix showing some example actions for the sake ofbrevity. Other types of actions may be included in the matrix,including, but not limited to, seen by a healthcare provider, furtherinvestigation initiated, consult health services, to name a few. Theaction matrix may be stored in the central computer system 110 to becompared to a vector of desired features. The desired features may becurrent user preferences and may take into account the user's currentexperience level. The recommendation engine 3612 may use one or moresimilarity metrics and a scoring algorithm to rank recommendations. Inan embodiment, the recommendation engine 3612 may generate a set offeatures that elevate recommendations in order to encourage brevity bychanging certain characteristics for an action from those that arerecommended. For example, if the recommendation engine 3612 ranks arecommendation high among retrieved recommendations, it may then changeone or more characteristics in order to increase a similarity score.Alternatively, the recommendation engine 3612 may change one or morecharacteristics in a retrieved recommendation, to one up or one down. Inone of more embodiments, the recommendation engine 3612 may adjust theaction to be more or less precise based on the experience level of thehealthcare provider.

The recommendation engine 3607 may output one or more recommendations toa recommendation user interface 3614. The recommendation user interface3614 may display a list of actions as the recommendations, in which onerecommendation may be selected.

FIG. 38 illustrates an exemplary summary of risks identified and whetherthey have been resolved. An ideal scenario is where the responsiblephysician has solved all identified risk assessment issues. If allidentified issues have been solved within the required time period, theresponsible physician needs to document the solution of the issues. Thehealthcare system will automatically save all risks that have beenidentified, and will provide a summary 3804 of the solved issues. In oneembodiment, the summary of issues 3804 will reflect the questions in therisk assessment form for the patient. In S752, the responsible physicianmay document whether the identified risks have been solved by selecting“YES” 3408 in the resolved column 3806.

FIG. 39 illustrates a subsequent escalation process in a case where theresponsible physician was not able to solve all risk assessment issueswithin the required time period. In S754, the health care system willperform a decision as to whether issues have been resolved with the timeperiod t1. In S756, if there are still unresolved issues, an escalationpathway will be determined and actions to resolve the unresolved issueswill be assessed.

In S760, the responsible physician may enter a consultant to beescalated to. It should be noted that an escalation process may be alateral escalation where the escalation process is to anotherresponsible physician, such as a responsible physician within anotherdepartment, being of a different specialty.

Referring to FIG. 39, in the case where the responsible physician wasnot able to solve at least one risk assessment issue, an interface maybe displayed that includes a list of checkboxes 3902 for actionsincluding a checkbox that is selected that, for example, indicates thatthe responsible physician was not able to resolve an identified issueand that escalation should be to a department chairmen. An e-mailmessage may be sent to the department chairmen that informs thedepartment chairmen that a risk assessment issue needs to be addressedfor a patient. Alternatively, the department chairmen may be contactedby a telephone call, text message, or pager. In S760, the responsiblephysician will document 3904 the name of the department chairmen thathas been contacted for the escalation pathway.

FIG. 40 illustrates a portion 4002 of a screen that may be displayed toa responsible physician in order to request a department chairmen tocosign. In the example, a department chairmen 4006 is selected from alist of physicians 4004 that may serve as a cosign for the responsiblephysician. In S762, the department chairmen will be notified by e-mailmessage, telephone call, text message and/or pager that their assistanceis being requested in order to resolve risk assessment issues that needto be resolved.

FIG. 41 illustrates a portion 4102 of a screen that may be displayed tothe recipient of the cosign request. The recipient may be subject to atime constraint, which may be set based on the scanning process of FIG.10. In S764, the screen display may show a list of checkboxes foractions that can be taken to resolve risk assessment issues. In S766,resolution of issues should be performed by a time T2. If riskassessment issues remain unresolved by the time T2, in S768, anescalation process will automatically be initiated. At this point,actions that have been taken in S764 may be sufficient to resolve allrisk assessment issues and the escalation process ends. In S770, ascreen display may show a list of checkboxes for actions that can betaken to resolve risk assessment issues. Again, actions that have beentaken in S770 may be sufficient to resolve all risk assessment issuesand the escalation process ends.

Referring back to FIG. 41, the recipient department chairmen may select4104 actions (select checkboxes) that they have taken to resolve thepatient's identified risk issues.

FIG. 42 illustrates a further escalation process that may occur when thedepartment chairmen could not resolve identified risk issues in S770. Inone embodiment, a further escalation process may be made to assign, inS774, the unresolved risk assessment issues, S772, to CCPID. The furtherescalation process 4202 may be initiated by selection 4204 of an actionthat indicates that issues remain unresolved and should be escalated toCCPID. An e-mail message may be sent to CCPID requesting that actionsrequire assistance to be resolved. In S776, CCPID may communicate withthe department chairmen, regional medical services, or chairmen toresolve remaining risk assessment issues within the remaining time.CCPID may be selected to request a cosign 4206. All actions taken toresolve remaining risk assessment issues may be documented for thepatient.

Numerous modifications and variations of the present invention arepossible in light of the above teachings. It is therefore to beunderstood that within the scope of the appended claims, the inventionmay be practiced otherwise than as specifically described herein.

1. A method for risk scoring and inpatient care coordination,comprising: collecting risk criteria for a patient during inpatient carewith a hybrid electronic ID/key system connected to a computer system;assessing one or more of the risk criteria for poorly coordinated carefor the patient during the inpatient care by a first medicalpractitioner, classifying a risk assessment of the poorly coordinatedcare based on the assessed criteria, wherein the risk assessment has aqualitative value of no risk, medium risk, and a high risk, wherein arisk assessment of medium risk is subject to resolution locally, whilepatients that have a risk assessment of high risk require escalation,wherein the collecting, assessing and classifying are carried out withthe hybrid electronic ID/key system connected to the computer system;wherein the hybrid electronic ID/key system further includes and thecomputer system is further connected to: a transmitter device havingcircuitry for storing ID data for the patient and transmitting a signalcontaining the ID data, and a key having a predetermined shape on asurface of the hybrid electronic ID/key; a radio frequency receptordevice having circuitry, storing location information, for detecting thesignal containing ID data, a matching detection section configured tomatch the predetermined shape of the key, and a movement trackingportion to track movement of the predetermined shape as the key isrotated; and wherein the computer system includes a patient database,configured to receive the ID data in conjunction with the locationinformation from the radio frequency receptor device when thepredetermined shape is completely rotated to a final position, and storethe ID data, location information, together with patient data associatedwith the location.
 2. (canceled)
 3. The method of claim 1, wherein theradio frequency receptor is configured to transmit a beginning time tomark beginning of care for the inpatient care for the patient when theprotruding predetermined shape is completely rotated to a position inwhich the notched portion comes into contact with an end of the cavityand creates a link between the ID data and the patient's electronicmedical record, wherein the computer system utilizes the link toelectronically record resolved medical issues together with the ID data,and wherein when at least one medical issue remains unresolved by theend of a time period based on the transmitted beginning time, anescalation process is initiated by the computer system.
 4. The method ofclaim 1, further comprising: at least one nursing station device incommunication with the computer system, the computer system furtherconfigured to extract medical history information for the patient fromthe patient electronic medical record during the inpatient care, the atleast one nursing station device configured to display the extractedmedical history information, and assess one or more of the criteria forpoorly coordinated care for the patient during the inpatient care by thefirst medical practitioner, when the risk assessment is high risk,determine an escalation process to be performed as a plurality ofpredetermined time periods based on the assessed criteria in order toescalate coordination of inpatient care to care performed by at leastone second medical practitioner and to resolve medical issues related tothe criteria for unresolved issues during care by the first medicalpractitioner within a first predetermined time period, in which thepredetermined time periods are conditioned based on resolution of themedical issues, assess actions taken by the second medical practitionerto resolve the unresolved medical issues related to the criteria for thepoorly coordinated care within the conditional time periods, therebyimproving timely quality of care of the patient, and record in thedatabase of the computer system, the assessed criteria, the riskassessment, the determined escalation process, and the actions taken inorder to relate the determined escalation process to the assessedcriteria.
 5. The method of claim 4, wherein the nursing station deviceis further configured to display the one or more criteria as a checkboxlist that includes one or more of the patient is not in an appropriatedepartment for current clinical needs, the patient is not beingevaluated by an appropriate MRP for the current clinical needs, thepatient requires one or more consultations, the patient has not beenphysically checked by a consultant for more than 24 hours of a requestfor consultation, a follow up physical check has not been performed formore than 48 hours, and the patient has had their procedure cancelled ordelayed due to non-clinical reason.
 6. The method of claim 4, whereinthe one or more criteria that require a quantitative value include oneor more of the patient requires one or more consultations, the patienthad a procedure cancelled or delayed due to non-clinical reason, andwherein the nursing station device is further configured to expand thedisplayed quantitative value criteria to a number of sub-criteria toaccommodate the quantitative value.
 7. The method of claim 6, whereinthe computer system is further configured to adjust the risk assessmentbased on a change in the quantitative value.
 8. The method of claim 4,wherein the computer system is further configured to dynamically train arecommender system model based on the recorded assessed criteria, a riskidentified, the actions taken and the escalation process.
 9. The methodof claim 8, wherein the recommender system model provides actions toresolve the medical issues related to the criteria for unresolved issuesduring care by the first medical practitioner within the firstpredetermined time period.
 10. The method of claim 4, wherein when theactions that are taken fail to resolve at least one criteria for poorlycoordinated care within the predetermined time periods, the computersystem is configured to perform a further escalation process to escalatecoordination of inpatient care to at least one next medicalpractitioner. 11-20. (canceled)